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Complicated tooth fracture

Tooth fracture

Summary

There are a number or reasons that a tooth fracture might be considered complicated.

  • Exposed nerve - the fracture may be big enough to expose the dental pulp
  • Sub-gingival - the fracture may extend below the gum line
  • Root fracture - it may be that the fracture extends all way down the root of the tooth

Home care advice

Complicated fracture as the name suggests are difficult to treat at home. There is a high chance that the tooth is extremely painful and we would recommend trying to speak to a dentist and ideally get an appointment if this is possible.

Please note it may be possible for the dentist to stick back the fragment of tooth (normally only front teeth). So try to keep the fragment and take it along to your appointment. There is evidence that if the fragment is stored in milk then the resultant strength of the bond when your dentist reattaches it may be stronger

Exposed nerve

If the nerve is exposed then the tooth is likely to be extremely painful. A dental appointment is advised as soon as possible s prompt treatment will great increase the chance of successfully saving the tooth. In the meantime controlling the pain and keeping the area clean is the order of the day:

  • Over the counter painkillers such paracetamol, paracetamol with codeine or a non steroidal anti-inflammatory drug (NSAID).Over 16 year olds can combine paracetamol and NSAIDs. CARE MUST BE TAKEN TO CHECK FOR ANY CONTRAINDICATIONS DUE TO EXISTING CONDITIONS, MEDICATIONS OR ALLERGIES.
  • Gels that anaesthetise (numb) the area. They usually contain either Benzocaine or lidocaine .
  • Clove oil can be applied using a small piece of cotton wool soaked in it for 10 sec.
  • Warm salt water rinses to keep the area clean
  • If it is not possible to see a dentist try to use a DIY temporary filling material to cover the nerve. This may not be possible especially in front teeth as it is unlikely to stick. If it is possible clean the area with a chlorhexidine mouthwash before applying
  • It may be more comfortable to sleep with your head raised

Sub-gingival Fracture

  • When a tooth breaks and the fracture line extends under the gum line then quite often the fragment stays in place and moves around when touched. So try not to eat on the area AT ALL until you can get an appointment. If it is painful there may also be a nerve exposure and the advice above may help with the pain.
  • This often occurs in root filled teeth. In which case the tooth is unlikely to be painful except when the fragment moves and tugs on the gum.
  • Keep the area as clean as possible using saline rinses, good brushing and carefully flossing of the area to prevent food getting into the fracture. Chlorhexidine gels can also help keep these areas clean.
  • It the fragment becomes very loose then try to gently remove it to prevent the risk of swallowing it.
  • When you manage to see a dentist they will establish whether the tooth can be save or whether and extraction will be necessary.

Root fracture

  • A fracture which extends into the root of the tooth is very likely to need extraction.
  • If the tooth was very broken down and root filled before it broke it may not be too painful except when biting on it.
  • If it is painful follow the same advice as above for Sub-gingival fracture and allow follow that cleaning regimen.

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References

Prabhakar AR, Yavagal CM, Limaye NS, Nadig B. Effect of storage media on fracture resistance of reattached tooth fragments using G-aenial Universal Flo. J Conserv Dent. 2016;19(3):250‐253. doi:10.4103/0972-0707.181942

Written by Andrew Bain BDS MJDF (RCS Eng)
Apr 27, 2020